Nkodo Amélie, Wu Iris, Hobgood Sarah, Celi Francesco S
Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA.
Department of Internal Medicine, Division of Geriatrics, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA.
JCEM Case Rep. 2023 Apr 21;1(2):luad037. doi: 10.1210/jcemcr/luad037. eCollection 2023 Mar.
Pheochromocytomas are rare neuroendocrine tumors that may secrete catecholamines, resulting in a wide array of clinical symptoms. While patients classically present with hypertension, headache, diaphoresis, and flushing, these symptoms are present in only 40% of cases. Here, we describe a 70-year-old woman whose predominant symptom was unexplained severe weight loss over a 12-month period associated with fatigue, anxiety, and palpitations at her endocrinologist and geriatrician visits. Diagnostic imaging was performed to assess for malignancy and demonstrated a 2.0 cm × 2.0 cm left adrenal mass. The diagnosis of pheochromocytoma was confirmed by elevated plasma normetanephrine levels. After a 2-week alpha blockade with doxazosin, the patient underwent robotic left adrenalectomy. Following surgery, the patient regained weight, and her hypertension also improved significantly. We hope this uncommon clinical presentation in an older adult characterized by weight loss and frailty will increase the awareness of atypical pheochromocytoma symptomatology, particularly in older individuals.
嗜铬细胞瘤是罕见的神经内分泌肿瘤，可分泌儿茶酚胺，导致一系列临床症状。虽然经典的患者表现为高血压、头痛、多汗和面部潮红，但这些症状仅在40%的病例中出现。在此，我们描述一名70岁女性，其主要症状是在12个月内原因不明的严重体重减轻，并在内分泌科医生和老年病科医生问诊时伴有疲劳、焦虑和心悸。进行诊断性影像学检查以评估是否为恶性肿瘤，结果显示左肾上腺有一个2.0 cm×2.0 cm的肿块。血浆去甲变肾上腺素水平升高证实了嗜铬细胞瘤的诊断。在用多沙唑嗪进行2周的α受体阻滞治疗后，患者接受了机器人辅助左肾上腺切除术。手术后，患者体重恢复，高血压也显著改善。我们希望这种以体重减轻和身体虚弱为特征的老年患者的罕见临床表现能够提高对非典型嗜铬细胞瘤症状的认识，尤其是在老年个体中。
